14 thoughts on “Why public spending cuts are an historic opportunity for UK healthcare”

  1. Posted 28/07/2009 at 10:42 | Permalink

    It has been said: ‘It’s a pity to waste a good crisis’; and I suppose we should be grateful to our politicians and regulators for engineering such a splendid one.

    The government has been, and plans to continue, overspending on such a grotesque scale that part of the ’solution’ must be for it to STOP DOING some of the things it has become accustomed to doing.

    Government interference makes thing worse in so many ways that simply not interfering will, by itself, allow things to get better.

    My only ‘rule’ by way of guidance would be: ‘No sacred cows’. That means: ‘No ring fencing.’ EVERYTHING the government does should be open to question. Certainly including provision of health services.

  2. Posted 28/07/2009 at 10:42 | Permalink

    It has been said: ‘It’s a pity to waste a good crisis’; and I suppose we should be grateful to our politicians and regulators for engineering such a splendid one.

    The government has been, and plans to continue, overspending on such a grotesque scale that part of the ’solution’ must be for it to STOP DOING some of the things it has become accustomed to doing.

    Government interference makes thing worse in so many ways that simply not interfering will, by itself, allow things to get better.

    My only ‘rule’ by way of guidance would be: ‘No sacred cows’. That means: ‘No ring fencing.’ EVERYTHING the government does should be open to question. Certainly including provision of health services.

  3. Posted 28/07/2009 at 11:15 | Permalink

    Excellent. That’s what most European countries do and it works fine.

    Let’s fix the ‘provision’ side first as you suggest, and leave the ‘funding side’ as a separate issue. Taxpayer funded basic level plus private top-ups or private insurance seems to be the way forward. Sure, the pressure for more spending (from patients or from ‘the industry’) tends to outweigh the pressure from the taxpayer, but as long as it’s clear what % of your income tax is spent on it, people will have to make up their own minds.

  4. Posted 28/07/2009 at 11:15 | Permalink

    Excellent. That’s what most European countries do and it works fine.

    Let’s fix the ‘provision’ side first as you suggest, and leave the ‘funding side’ as a separate issue. Taxpayer funded basic level plus private top-ups or private insurance seems to be the way forward. Sure, the pressure for more spending (from patients or from ‘the industry’) tends to outweigh the pressure from the taxpayer, but as long as it’s clear what % of your income tax is spent on it, people will have to make up their own minds.

  5. Posted 28/07/2009 at 11:30 | Permalink

    Attention also needs to be given to ’supply-side’ reforms to facilitate competition and keep costs under control. In particular, the General Medical Council should be stripped of its statutory role and patients should be free to choose between registered and unregistered practitioners. In many instances treatment does not require the services of a highly trained and expensive GMC-approved doctor.

  6. Posted 28/07/2009 at 11:30 | Permalink

    Attention also needs to be given to ’supply-side’ reforms to facilitate competition and keep costs under control. In particular, the General Medical Council should be stripped of its statutory role and patients should be free to choose between registered and unregistered practitioners. In many instances treatment does not require the services of a highly trained and expensive GMC-approved doctor.

  7. Posted 28/07/2009 at 13:45 | Permalink

    PS. D R Myddleton had a fine reader’s letter in today’s FT.

    http://www.ft.com/cms/s/0/bebc6290-7b0e-11de-8c34-00144feabdc0.html?nclick_check=1

  8. Posted 28/07/2009 at 13:45 | Permalink

    PS. D R Myddleton had a fine reader’s letter in today’s FT.

    http://www.ft.com/cms/s/0/bebc6290-7b0e-11de-8c34-00144feabdc0.html?nclick_check=1

  9. Posted 28/07/2009 at 20:16 | Permalink

    I agree with Richard – one side effect of the “free at the point of use” illusion, coupled with regulation, is that the healthcare sector has never really developed a low-cost “routine segment”.
    If the rearlight of a bicycle breaks off, we wouldn’t go to a specialised bike repair shop either. We would get a new one at a department store. If the gearshift breaks down, that would be the right moment to go to a bike shop.
    Along the same lines, many routine cases could be seen by nurses, if regulation did not impede it and if it paid off for the individual to use expensive services cautiously. Swiss and Dutch health insurers already give rebates to clients who consult a subsidiary level first.

  10. Posted 28/07/2009 at 20:16 | Permalink

    I agree with Richard – one side effect of the “free at the point of use” illusion, coupled with regulation, is that the healthcare sector has never really developed a low-cost “routine segment”.
    If the rearlight of a bicycle breaks off, we wouldn’t go to a specialised bike repair shop either. We would get a new one at a department store. If the gearshift breaks down, that would be the right moment to go to a bike shop.
    Along the same lines, many routine cases could be seen by nurses, if regulation did not impede it and if it paid off for the individual to use expensive services cautiously. Swiss and Dutch health insurers already give rebates to clients who consult a subsidiary level first.

  11. Posted 28/07/2009 at 21:01 | Permalink

    Thank you Mark! The FT telephoned beforehand to change a word: they didn’t like my saying that Sam Brittan had ’sneered at’ Victorians — so we agreed to change it to ‘criticised’. But what a nerve to complain about the level of the National Debt under the Victorians!

  12. Posted 28/07/2009 at 21:01 | Permalink

    Thank you Mark! The FT telephoned beforehand to change a word: they didn’t like my saying that Sam Brittan had ’sneered at’ Victorians — so we agreed to change it to ‘criticised’. But what a nerve to complain about the level of the National Debt under the Victorians!

  13. Posted 29/07/2009 at 11:40 | Permalink

    I always thought we should have a National Healthcare System, not the NHS.

    Base this on vouchers to buy health insurance at £1,000pa per person and that costs £60 billion. Retain £25 billion to run ambulance and A&E centres across the country, £10bn to provide free care for the terminally ill and those at the extreme end of their lives and then put £5bn a year in to research.

    As Helen suggests, all provision is then “private”, ie non-state, except for emergencies and end of life care.

  14. Posted 29/07/2009 at 11:40 | Permalink

    I always thought we should have a National Healthcare System, not the NHS.

    Base this on vouchers to buy health insurance at £1,000pa per person and that costs £60 billion. Retain £25 billion to run ambulance and A&E centres across the country, £10bn to provide free care for the terminally ill and those at the extreme end of their lives and then put £5bn a year in to research.

    As Helen suggests, all provision is then “private”, ie non-state, except for emergencies and end of life care.

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